The background of dilation inventions for percutaneous tracheotomy discussed here include a number of devices which are selected for use depending on physician preference and factors such as the physical characteristics of the patient.
Devices in medical use for tracheotomies or tracheostomies are preceded in use by identifying the area for the opening to be created puncturing the area, between sterna notch and cricoid (tracheal) cartilage rings, with a syringe and needle removing the syringe from the needle, which remains in place passing a ‘flexible (j-wire) guide’, through the needle
This ‘flexible (j-wire) guide’ remains in place for the duration of a′ typical percutaneous tracheotomy procedure.
Once this ‘flexible (j-wire) guide’ is in place in the opening,
a monolithic semi-rigid dilator is passed over the ‘flexible (j-wire) guide’ (threading the available end of the ‘flexible (j-wire) guide’ through the dilator) and used to begin increasing the size of opening between cartilage rings to be bigger than the syringe needle which was previously removed
passing another, larger dilator device, or series of progressively larger devices over the ‘flexible (j-wire) guide’, to create the final opening
A percutaneous tracheotomy is used for example, as the tracheal wall has anisotropic properties which illustrate the advantages and versatility of the dilator.
Griggs Forceps
Griggs forceps are a scissor-like tool which includes a partial passage created by recess channels on each of the mating surfaces of the grasping ends of the forceps. These partial passages form a complete passage when the forceps are closed, allowing the forceps to be guided by the ‘flexible (j-wire) guide’. The closed forceps are passed into the opening created by the syringe/needle/dilator and then opened and closed, rotated, opened and closed, rotated, etc. . . . until such time as the opening created is of sufficient size and shape.
Drawbacks of the forceps are that they act in a single plane at any one time; they do not have a stop (limit of travel); and their orientation and range of motion is dependent on the strength and skill of the surgeon.
Blue Rhino Trach
The ‘Blue Rhino Trach (BRT)’ is a tapered plastic tool with an angled tip, which includes an internal passage to be guided by the ‘flexible (j-wire) guide’. The ‘BRT’ is passed into the opening created by the syringe/needle/dilator and then pushed and released, pushed and released, pushed and released, etc. . . . until such time as the opening created is of sufficient size.
Drawbacks of the ‘BRT’ are that the lateral spread is achieved through a high insertion force, by the tapered outer diameter of the device; and this high insertion force and resultant deflection takes the tip of the device dangerously close the anterior (far) wall of the trachea, where damage which can lead to fatal infection can occur to the patient.
Blue Dolphin Trach
The ‘Blue Dolphin Trach (BDT)’ is an un-deployed reinforced plastic balloon in a delivery tube, which includes an internal passage to be guided by the ‘flexible (j-wire) guide’. The ‘BDT’ is passed into the opening created by the syringe/needle/dilator and then inflated, to create an opening of sufficient size.
Drawbacks of the ‘BDT’ are the ‘explosive force involved in deployment within the patient; the danger of certain accompanying equipment in the operating arena; and the risk of the balloon bursting or becoming loose inside the patient.
Percu-Twist
The ‘Percu-Twist’ is a screw-like tool which includes a partial passage to be guided by the ‘flexible (j-wire) guide’. The Percu-Twist′ is passed into the opening created by the syringe/needle/dilator and then, rotated, rotated, rotated, rotated, etc. . . . until such time as the opening created is of sufficient size.
The chief drawback of the Percu-Twist′ is the excessive torsional load placed on the tissue of the patient's trachea during application of rotary motion, causing the tissue to ‘wind up’ around the tool during its use. It also takes as much time to remove as to deploy.
Trocar
A ‘Trocar’ can be an un-deployed reinforced stent in a delivery tube, which includes an internal passage to be guided by the ‘flexible (j-wire) guide’. The ‘Trocar’ is ‘shot’ into the opening created by the syringe/needle/dilator whereupon it expands and stabilizes, to create an opening of sufficient size.
Drawbacks of the ‘trocar’ are the ‘violent force involved in a deployment within the patient; the danger of range of motion in use; the risk of the non-deterministic and incorrect location in the patient. It is also subject to removal difficulties.
In the previous examples, some of the dilators will always retain the ‘flexible (j-wire) guide’, since they are effectively cylinders into which the flexible (j-wire) guide′ is threaded, during the first stage of dilation.
The Griggs Forceps can ‘lose’ the ‘flexible (j-wire) guide’ when they are opened. If, for some reason, it is desired to re-engage the ‘flexible (j-wire) guide’, the forceps may be removed from the orifice, closed, re-threaded, and re-inserted.
The background discussed here is limited to particular application of dilators in percutaneous tracheotomies and tracheostomies. Similar dilators are used to create other types of openings in other medical and veterinary applications, as well as industrial applications.
It is not meant for the invention described herein to be limited in its application to percutaneous tracheotomies and tracheostomies, based on the background information provided here.